Skill Checkup: A 62-Year-Old Man With Lumps on His Neck and Under His Arm

Ann S. LaCasce, MD, MMSc


May 25, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 62-year-old man in the United States presents to the clinic with a lump growing on his neck and under his arm. His only other complaint is occasional night sweats. The patient is 5 ft 9 in (1.75 m) and weighs 165 lb (74.84 kg). Vital signs are within normal range, and he is generally fit. Physical examination reveals enlargement of dorsal cervical and axillary lymph nodes. Laboratory values include a white blood cell count of 5.2 × 109/L, lymphocyte count of 5000/µL, hemoglobin level of 11.2 g/dL, lactate dehydrogenase level of 646 U/L, and a platelet count of 169 × 109/L. Peripheral blood flow cytometry demonstrated a population of lambda-restricted, clonal B cells that were CD20 bright, CD5 positive, and CD23 negative. Fluorescence in situ hybridization (FISH) reveals a (11;14) translocation [t(11;14)].


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